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目的观察急性髓系白血病(AML)行异基因造血干细胞移植(allo-HSCT)后血液学复发,应用FLAG方案联合粒细胞集落刺激因子动员的供者淋巴细胞输注(G-DLI)治疗的临床疗效。方法对于接受异基因外周血造血干细胞移植(allo-PBSCT)后复发的患者,给予FLAG方案化疗后在白细胞降至最低点时给予G-DLI,观察白血病缓解及生存情况,并通过PubMed等检索进行文献复习。结果 3例移植术后复发接受FLAG方案联合G-DLI治疗者均再次获得完全缓解(CR)。1例G-DLI后无病存活(DFS)13个月,后出现中枢复发,但骨髓一直处于缓解状态,23个月后因多脏器功能衰竭死亡,总生存(OS)为23个月。GDLI后发生皮肤Ⅱ度急性高移植物抗宿主病(GVHD)及肝脏Ⅰ度急性GVHD,经处理后控制,未发生慢性GVHD。1例G-DLI后12个月再次骨髓复发,放弃治疗于1个月后死亡,DFS及OS分别为12、13个月。G-DLI后发生局限性皮肤慢性GVHD,给予小剂量免疫抑制剂后得到控制。1例G-DLI后无病存活至今,DFS为16个月。G-DLI后发生局限性皮肤慢性GVHD,给予小剂量免疫抑制剂后得到控制。结论 FLAG方案联合G-DLI可能是AML行allo-HSCT术后复发的有效治疗方式之一。
Objective To observe the clinical data of hematological relapse after allo-HSCT with acute myeloid leukemia (AML) and the application of granulocyte-colony-stimulating factor mobilizing granulocyte-colony stimulating factor (G-DLI) Efficacy. Methods G-DLI was given to patients who relapsed after allo-PBSCT (allo-PBSCT) with FLAG regimen and the leukocyte count was reduced to the lowest point. The remission and survival of leukemia were observed and searched by PubMed Literature review. Results All 3 patients who received FLAG regimen combined with G-DLI had complete remission (CR) after transplantation. One case of disease-free survival (DFS) after 13 months of G-DLI had a central recurrence, but the bone marrow remained in a state of remission and died of multiple organ failure after 23 months. The overall survival (OS) was 23 months. GDLI occurred after severe acute graft-versus-host disease (GVHD) and acute GVHD in liver, which were controlled after treatment and did not cause chronic GVHD. One case of G-DLI 12 months after bone marrow recurrence, to give up treatment after 1 month of death, DFS and OS were 12,13 months. Locally localized chronic GVHD occurs after G-DLI and is controlled by the administration of low-dose immunosuppressive agents. One case of G-DLI disease-free survival so far, DFS for 16 months. Locally localized chronic GVHD occurs after G-DLI and is controlled by the administration of low-dose immunosuppressive agents. Conclusion FLAG combined with G-DLI may be one of the effective treatments for allo-HSCT recurrence after AML.